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OB/Gyn > Infertility > Flashcards

Infertility Flashcards

0
Q

What is secondary infertility?

A

conceived at least once and not again for at least one year

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1
Q

what is primary infertility?

A

never conceived

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2
Q

What is FMS?

A

follicular maturation study

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3
Q

What is one part of hx that is important in infertility?

A

how long the couple has been trying to conceive

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4
Q

What are the prime causes of infertility?

A

most common = unexplained

sperm problem

ovulatory failure

tubal damage

endometriosis/cervical mucous

coital problems

other

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5
Q

what are the steps of conception?

A

ovulation

insemination

fertilization

transportation

implantation

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6
Q

What do you evaluate with infertility as it pertains to the cervix?

A

provide non-hostile environment to harbor sperm

glands that secrete mucus and crypts that hold sperm

ultrasound: used to evaluate cervical length during pregnancy to assess for cervical incompetence

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7
Q

What are you evaluating considering infertility in relation to the uterus?

A

assess structural anatomy

assess endometrium

assessing for structural anatomy refers to evaluating uterine shape DES exposure

echogenicity

masses - fibroids

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8
Q

What would you asses in the endometrium in relation to infertility?

A

echogenicity

masses - fibroids

assess endometrium

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9
Q

When would you measure the endometrium for appropriate change?

A

throughout the menstrual cycle

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10
Q

what happens in the first part of the menstrual cycle as it pertains to infertility?

A

mucosa begins to proliferate because of increasing estrogen levels

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11
Q

after ovulation progesterone is secreted by _________

A

corpus luteum

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12
Q

secretion of progesterone begins what

A

the secretory phase of the endometrial cycle

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13
Q

during the secretory phase, endometrium becomes ___________ and very __________ as result of ________ ________

A

thickened

very echogenic as a result of stromal edema

loos of triple line sign

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14
Q

how big does the endometrium need to be in order to achieve pregnancy?

A

at least 6 mm

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15
Q

if there is not enough progesterone produced in the luteal phase what kind of endometrial lining will you see by US?

A

thin lining

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16
Q

what is the lack of progesterone production known as what?

A

luteal phase deficiency

may be associated with infertility and early pregnancy loss

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17
Q

why is endometrial appearance important?

A

for planning for infertility treatment with embryo transfer

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18
Q

What can cause irregular endometrium?

A

submucosal fibroids

polyps

adhesions

synechiae (scarring)

19
Q

what procedure do you do in order to see abnormal structures in the endometrium?

A

SIS (saline infusion sonography) aka sonohysterogram

further delineates anatomic structure of the endometrium

20
Q

With infertility, what are you looking for when evaluating the Fallopian tubes?

A

hydrosalpinx

tubal patency

21
Q

What do you assess in the endometrium?

A

evaluate thickness

echogenicity characteristics

evaluate intracavitary lesions

22
Q

What causes a 50% reduction in pregnancy rate and doubling of spontaneous miscarriage rate?

A

hydrosalpinx

23
Q

Removing what structure improves in vitro fertilization success?

A

Fallopian tubes

24
Q

How do you determine tubal patency?

A

assessed by injecting saline into tube and looking for spillage of fluid into cul-de-sac or by using contrast to evaluate for spillage.

25
Q

where do sonographers look for spillage of saline or air?

A

around the ovary

into the posterior cul-de-sac

26
Q

During the procedure to check for spillage, if none is noted and the patient complains of pain during injection, what might be the problem?

A

blocked Fallopian tube

27
Q

What can obstruct the Fallopian tube?

A

adhesions

28
Q

What is the normal ovary/follicle?

A

during follicular phase:

several antral follicles on ovary < 5mm

dominant follicle grow 1-3mm/day until reaches about 22mm

22mm follicle ruptures (will either increase or decrease in size)

Sonographic findings:

echoes within fluid left behind (corpus luteum cyst)

free fluid in peritoneal cavity

29
Q

What are the key drugs used in ovarian induction therapy?

A

clomiphene citrate (clomid) oral

human menopausal gonadotropins (pergonal) injected

30
Q

Once ovarian induction therapy is started when is ultrasound used to monitor number and size of follicles?

A

days 8 to 14 (follicular phase) of menstrual cycle

count and measure all follicles > 1cm in sag and trv planes

31
Q

With ovarian induction therapy, what is the optimal mean measurement of the mature follicles?

A

between 16 and 20 mm

32
Q

What is correct measurement of folllicles important?

A

because hCG (substitute for LH) may need to be given intramuscularly to trigger ovulation (Pergonal)

33
Q

With ovarian induction therapy, What should the endometrium be doing?

A

Assess thickness and echogenicity pattern of endo cavity

normal endo response assoc with ovarian stimulation is 2-3mm to 12-14mm

sonographically:

measure endo thickness - trv uterus transvag in sag plane

measure from anterior to posterior endometrial interface

34
Q

What is OHSS (ovarian hyperstimulation)?

A

syndrome that presents sonographically as enlarged ovaries with multiple cysts, abdominal ascites and pleural effusions

35
Q

If a patient has OHSS what actions are taken?

A

patient will be removed from medication immediately and may be off for several months

36
Q

What is assisted reproductive technology - ART?

A

in vitro fertilization (IVF) is the method of fertilizing the human oocyte outside the body

treatment plan: ovarian monitoring, needle aspiration of oocytes, incubation of oocytes, fertilization and transferring embryos into uterus

37
Q

How is oocyte retrieval accomplished with what?

A

transvaginal ultrasound guidance

38
Q

how many follicles are evaluated for IVF, 2 or 4?

A

4

39
Q

How do the doctors get control of the cycle?

A

by using Lupron or Synarel - stops ovarian function

40
Q

what are the complications of ART?

A

OHSS

Ectopic - heterotrophic pregnancies higher risk with ART patients

multiple gestations

41
Q

What is anovulation?

A

failure of hypothalamus and pituitary to produce hormones to stimulate ovuation

FINISH slide 42

42
Q

Does regular menses guarantee the ovulation of an oocyte?

A

no

43
Q

What is luteal phase inadequacy?

A

inadequate output of progesterone in second half of cycle

creating thin endometrium

44
Q

what shape of uterus has the highest rate of infertility?

A

septate

45
Q

What are the most common factors that may cause infertility?

A

low sperm count

anatomic defects

disease

Fallopian tube scarring

OB/Gyn (14 decks)

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